Medical treatment of end-stage heart failure

Cardiovascular Drugs and Therapy
G BinettiR Fiocchi

Abstract

Congestive heart failure is a lethal condition that affects an increasing number of patients. In recent years a great amount of data have accumulated on the pathophysiology and medical and surgical therapy of this condition. In spite of the advances in its management and the great number of patients affected, common errors are still made by internists and cardiologists in the use of drugs and therapeutic strategies. Digitalis has only recently been shown to affect hemodynamics, exercise capacity, and clinical symptoms, but the effects on survival still have to be demonstrated. Loop diuretics, eventually combined with thiazides and antialdosterone drugs in patients with clinical signs and symptoms of fluid retention, are the mainstays of therapy of congestive heart failure. In order to make diuretic therapy efficacious, moderate salt and water intake restriction is mandatory. Angiotensin-converting enzyme (ACE) inhibitors are now considered unavoidable drugs in the management of heart failure, and an attempt to reach the doses that have been shown to be efficacious for survival in the large trials has to be made in every patient with this condition. Other vasodilators, such as hydralazine and nitrates, which show a less pronounc...Continue Reading

References

Jan 1, 1990·Journal of the American College of Cardiology·J S GibbsP A Poole-Wilson
May 1, 1989·Journal of the American College of Cardiology·R A WinkleT Shipman
Jul 1, 1987·The American Journal of Medicine·A RimondiniM D Guazzi
Oct 1, 1993·Journal of the American College of Cardiology·R A Kelly, T W Smith
Oct 1, 1993·Journal of the American College of Cardiology·A J Coats
Jan 21, 1993·The American Journal of Cardiology·K T Weber, D Villarreal
Mar 1, 1995·Journal of Cardiac Failure·J N Cohn

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